Incidence and Outcomes of Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Registry-based Descriptive Trial in Kobe City

  • OHTA Tsuyoshi
    Department of Neurosurgery, Kobe City Medical Center General Hospital
  • MATSUMOTO Shirabe
    Department of Neurosurgery, Kobe City Medical Center General Hospital
  • FUKUMITSU Ryu
    Department of Neurosurgery, Kobe City Medical Center General Hospital
  • IMAMURA Hirotoshi
    Department of Neurosurgery, Kobe City Medical Center General Hospital
  • ADACHI Hidemitsu
    Department of Neurosurgery, Kobe City Medical Center West Hospital
  • HARA Yoshie
    Department of Neurosurgery, Hyogo Emergency Medical Center and Kobe Red Cross Hospital
  • HOSODA Kohkichi
    Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center
  • KIMURA Hidehito
    Department of Neurosurgery, Kobe University Graduate School of Medicine
  • KUWAYAMA Kazuyuki
    Department of Neurosurgery, Japan Community Health Care Organization Kobe Central Hospital
  • MIZOWAKI Takashi
    Department of Neurosurgery, Shinsuma General Hospital
  • MOTOOKA Yasuhiko
    Department of Neurosurgery, Konan Medical Center
  • MIYATA Shiro
    Department of Neurosurgery, Kobe Ekisaikai Hospital
  • SHINODA Narihide
    Department of Neurosurgery, Kosei Hospital
  • UENO Yasushi
    Department of Neurosurgery, Shinko Memorial Hospital
  • YAMAURA Ikuya
    Department of Neurosurgery, Cerebrovascular Research Institute, Yoshida Hospital
  • YOSHIDA Yasuhisa
    Department of Neurosurgery, Cerebrovascular Research Institute, Yoshida Hospital
  • SAKAI Chiaki
    Department of Neurovascular Research, Kobe City Medical Center General Hospital
  • SAKAI Nobuyuki
    Department of Neurovascular Research, Kobe City Medical Center General Hospital

抄録

<p>The current study aims to evaluate the incidence and results of aneurysmal subarachnoid hemorrhage (aSAH) throughout Kobe City. Based on a multicenter retrospective registry-based descriptive trial involving all 13 primary stroke centers in Kobe City, patients with aSAH treated between October 2017 and September 2019 were studied. A total of 334 patients were included, with an estimated age-adjusted incidence of 11.12 per 100,000 person-years. Curative treatment was given to 94% of patients, with endovascular treatment (51%) preferred over surgical treatment (43%). Of the patients, 12% were treated by shunt surgery for sequential hydrocephalus with a worse outcome at 30 days or discharge (14% vs. 46%, odds ratio (OR): 0.19, 95% confidence interval (CI): 0.088-0.39, p-value <0.001). As for vasospasm and delayed cerebral ischemia, most patients were given intravenous fasudil infusion (73%), with endovascular treatment for vasospasm in 24 cases (7.2%). The fasudil group had more good outcomes (42% vs. 30%, OR: 1.64, 95% CI: 0.95-2.87, p-value = 0.075) and significantly less death (3.3% vs. 35%, OR: 0.064, 95% CI: 0.024-0.15, p-value <0.001) at 30 days or discharge. Mortality rose from 12% at 30 days or discharge to 17% at 1 year, but neurological function distribution improved over time (modified Rankin Scale 0-2 was 39% at 30 days or discharge, 53% at 60 days, and 63% at 1 year). Our retrospective registered trial presented various statistics on aSAH, summarizing the current treatment status and prognosis.</p>

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